can be accomplished at pre-implantation
of an embryo. It has been marketed
under the title family balancing.
There are two major types of pre-implantation
methods which can be used for sex
selection.

Human
sex selection can be accomplished at pre-implantation
of an embryo. It has been marketed under
the title family balancing. There are two
major types of pre-implantation methods
which can be used for sex selection.

Sperm
sorting - The separation of
X Chromosome sperm from Y Chromosome
sperm. The resulting sorted sperm are
used in either artificial insemination
or in-vitro fertilization (IVF) procedures.

Pre-implantation
genetic diagnosis (PGD) - In
sex selection cases, embryos resulting
from IVF procedures are genetically
tested for X or Y Chromosomes. The embryos
of the desired sex are then implanted.

More
support for sex selection

The American Society
for Reproductive Medicine has paved the
way for its members to help couples choose
the sex of their babies. Australian professionals,
however, remain divided on the issue. A
report from the American Society's Ethics
Committee says that the use of medical technologies
by couples seeking "gender variety"
in their offspring is acceptable under certain
conditions. The
stand is a relaxation of an earlier position,
which held that the use of IVF and pre-implantation
genetic diagnosis for the sole purpose of
sex selection should be "discouraged"
because it holds the risk of "unwarranted
gender bias, social harm and the diversion
of medical resources from genuine medical
need". "They've
certainly become more liberal in their view,"
comments Dr Julian Savulescu of the Murdoch
Childrens Research Institute. Dr
Savulescu is an advocate for sex selection.
He argues that objections to medically assisted
sex selection based on possible harm to
the child, the parents, or society, are
not compelling, particularly in Australia.

In
addition to pre-implantation genetic diagnosis
(PGD), a foetus's sex can also be tested
using chorionic villus sampling (CVS) at
around 11 weeks, followed by abortion if
it is the 'wrong' sex. While
Dr Savulescu acknowledges that the CVS technique
carries increased risks of miscarriage,
he says that PGD has been shown to be safe
and that 300 children had been born world-wide
using the technology. Professor
Gab Kovacs, of the Royal Australian and
New Zealand College of Obstetricians and
Gynaecologists and Monash IVF, says the
College does not condone discarding embryos
on the basis of sex. However, he says, there
may be an argument for sex selection in
some circumstances. "One
must look at the best interests of the child.
If the parents are obsessed enough to try
and have a child of a particular sex, it
may be in the child's best interest to make
sure it is the sex that is desired."

There
are no national laws governing sex selection
in Australia. Sex selection is available
through a company in Sydney but is banned
in some states, including Victoria and South
Australia.

Sex
selection "inevitable"

The
University of Tasmania's Dr Chris Newell
says that the ethical acceptability of embryo
sex selection is "inevitable"
if people accept the selection of embryos
on the basis of disease."It's
a logical extension," he says. "If
you argue it's the parent's right to choose,
how can you say it's okay for them to choose
on the basis of one characteristic but not
on another?"Dr
Savulescu argues there may be a case for
differential application of sex selection
technologies. They may be less appropriate
in countries like India and China, where
it may be better to try and reduce systematic
discrimination against females rather than
the number of females born, he says.However,
Dr Savulescu does not think social conditions
in different countries can be used to argue
against selection on the basis of disability
- because disability, unlike gender, he
says, is "inherently bad".Dr
Newell disagrees: "Disability is not
inherently bad. Most of the problems caused
by disability are the stigma and discrimination
by society. Just like gender, the acceptability
of disability and ethnicity depends on society."Dr
Newell describes the debate on this issue
in Ausralia as "impoverished".

"We
need to move beyond the right of couples
to choose, to asking whether it is good
ethics to select various attributes for
our children," he says.

Boy
or Girl?

News
of a US study, launched to investigate the
social effects of allowing parents to choose
the sex of their child, has re-focused attention
on the contentious issues surrounding sex
selection. Dominique Driver delves into
the UK government’s current policy on the
use of reproductive technologies, and asks
how the public in the UK feels about sex
selection.

Sandra Carson and her team needed nine years
to gain approval from their review board
at Baylor College of Medicine in Houston,
Texas. The study will be made possible by
a technique known as Pre-implantation Genetic
Diagnosis (PGD). PGD involves extracting
the DNA of a single cell of an eight-cell
stage embryo created by In Vitro Fertilisation
(IVF) for determining the sex as well as
checking for genetic abnormalities. After
result evaluation, the ‘desired’ embryos
can then be implanted into the mother’s
uterus. At least fifty couples are currently
lined up to take part in the trial, but
only those who already have a child of the
opposite sex will be enrolled, a practice
known as ‘family balancing’. The
use of PGD for sex selection is legal in
the US, though, the American Society for
Reproductive Medicine (ASRM) and the American
College of Obstetricians and Gynecologists
(ACOG) have openly stated their opposition
to using PGD in this way. Across the Atlantic,
at the UK front, social sex selection is
currently banned and the Human Fertility
and Embryology Authority (HFEA) who regulate
the all reproductive technology will only
licence PGD for serious medical conditions.

Yet
not everyone is in agreement over the HFEA’s
decision to invoke the precautionary principle
when it comes to reproductive technology.
Earlier this year, after reviewing the 1990
Human Fertilisation and Embryology (HFE)
Act, the House of Commons Science and Technology
Committee tentatively recommended that the
ban should be withdrawn. The committee contended
that there was little evidence to support
the HFEA’s position: “It concerns us that
the potential for harm is often quoted without
recourse to a growing body of evidence of
its absence…the bonus should be on those
who oppose sex selection for social reasons
using PGD to show harm from its use.” Although
the committee recognised that the majority
of the British public are currently against
sex selection, they concluded that: “on
balance we find no adequate justification
for prohibiting the use of sex selection
for family balancing”. However they steered
clear of recommending the more controversial
uses of sex selection, such as in helping
rebuild a family that has suffered the loss
of a child, or to support economic, cultural
or social preferences for one gender over
the other. These are often considered more
problematic because of the possible psychological
effects on the families, the view that these
practices may be sexually discriminating,
and the potential they have to skew the
gender ratio in certain communities.

Together
with social and demographic considerations,
social sex selection raised an array of
ethical concerns. Some fear that by allowing
sex selection for social purposes we are
no longer valuing children for who they
are, and may be leaving the door open to
the selection of further non-medical traits,
creating so-called ‘designer babies’. Dr
Rony Duncan, Researcher in the Medical Ethics
Unit at Imperial College, believes that
although there is an ethical distinction
between sex selection for medical reasons
and sex selection for social purposes, both
are ethically acceptable. “Some people with
two boys want a girl. Some people want a
boy first. Others only want girls. People
have had preferences about the sex of their
children for centuries. We now simply have
an accurate way of helping them”. He explains
that in ethical terms the difference lies
in the motivation for each, but argues that
there is nothing inherently wrong with wanting
to have a child of one sex over the other.
“There is no evidence that having a preference
for the sex of your child makes you a bad
parent, or harms the future child. Parents
should be able to choose the sex of their
children, whether it’s to increase the chances
of them having a healthy child or simply
because they want to”.

However,
while the current ban remains in place it
will be impossible for UK researchers to
assemble conclusive evidence on the effects
of social sex selection, something the US
trial will hopefully go some way towards
providing. Dr Peter Mills, Policy Development
and Co-ordination Manager at the HFEA agrees
that the US study may help to shed light
on these issues: “Although the Authority
has indicated that it does not regard sex
selection by PGD for non-medical reasons
as an appropriate use of reproductive technology
and would therefore be unlikely to licence
it in the UK, the results of any well-designed
follow-up research may well advance some
of the arguments around this contentious
use of the technology”. Where
does that leave us now? In response to the
recommendations of the House of Commons
Science and Technology Committee, the government
issued a statement maintaining that: “The
government has no plans to alter this position
to allow sex selection other than for compelling
medical reasons.” But as part of its review
of the HFE Act, the government has also
conducted a public consultation into whether
sex selection should be permitted for family
balancing purposes, the results of which
should be available next year. Dr Mills
of the HFEA insists that in the meantime:
“The Authority will continue to keep emerging
evidence and argument under review, including
information about the risks associated with
the techniques and about the consequences
of their use.”

So
should we be embracing this potential use
of reproductive technology? The jury is
still out, but if pressure from the government
continues to grow, the HFEA may be forced
to rethink its position, or provide compelling
justification for standing by its current
policy. The assertion that the bulk of the
general public oppose social sex selection
may simply not be enough.